LANCET
`
`LONDON ANALPIMORE SATURDAY 18 AUGUST 1990
`
`No 8712
`
`yoi 336 (cid:9)
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`No 8712
`
`'MEDICAL SCIENCE
`LONDON ANttALIIMORE SATURDAY 18 AUGUST 1990
`Ultrasound screening and perinatal mortality: controlled trial of systematic
`one-stage screening in pregnancy
`'MEDICAL SCIENCE
`Aulikki Saari-Kemppainen, Olavi Karjalainen, Pekka YlOstalo, 0. P. Heinonen
`Ultrasound screening and perinatal mortality: controlled trial of systematic
`Enhancement of recovery from psychiatric illness by methylfolate
`one-stage screening in pregnancy
`P. S. A. Godfrey, B. K. Toone, M. W. P. Carney, T. G. Flynn, T. Bottiglieri,
`Aulikki Saari-Kemppainen, Olavi Karjalainen, Pekka YlOstalo, 0. P. Heinonen
`M. Laundy, I. Chanarin, E. H. Reynolds
`Enhancement of recovery from psychiatric illness by methylfolate (cid:9)
`Do changes in pattern of breast usage alter the baby's nutrient intake?
`P. S. A. Godfrey, B. K. Toone, M. W. P. Carney, T. G. Flynn, T. Bottiglieri,
`M. W. Woolridge, J. C. Ingram, J. D. Baum
`M. Laundy, I. Chanarin, E. H. Reynolds
`kecurrent lesions in human Leishmania braziliensis infection—reactivation
`Do changes in pattern of breast usage alter the baby's nutrient intake?
`or reinfection?
`M. W. Woolridge, J. C. Ingram, J. D. Baum
`N. G. Saravia, Kristen Weigle, Iris Segura, S. H. Giannini, Raquel Pacheco,
`kecurrent lesions in human Leishmania braziliensis infection—reactivation
`L. A. Labrada, Antonio Goncalves
`or reinfection?
`Pancreatic islet transplantation after upper abdominal exenteration and
`N. G. Saravia, Kristen Weigle, Iris Segura, S. H. Giannini, Raquel Pacheco,
`liver replacement
`L. A. Labrada, Antonio Goncalves
`A. G. Tzakis, Camillo Ricordi, Rodolfo Alejandro, Yijun Zeng, J. J. Fung, Satoru Todo,
`Pancreatic islet transplantation after upper abdominal exenteration and
`A. J. Demetris, D. H. Mintz, T. E. Starzl
`liver replacement
`EDITORIALS
`A. G. Tzakis, Camillo Ricordi, Rodolfo Alejandro, Yijun Zeng, J. J. Fung, Satoru Todo,
`A. J. Demetris, D. H. Mintz, T. E. Starzl
`407 (cid:9)
`Endobronchial treatment for tracheobronchial
`Hantavirus disease
`408 (cid:9)
`EDITORIALS
`410
`tumours (cid:9)
`Real insight
`411
`Endoscopic transanal resection
`407 (cid:9)
`Hantavirus disease
`Endobronchial treatment for tracheobronchial
`410 (cid:9)
`412
`Cuff-link
`Precocious familial gout
`408 (cid:9)
`Real insight
`410
`tumours
`411
`Endoscopic transanal resection
`CLINICAL PRACTICE
`410 (cid:9)
`412
`Cuff-link
`Precocious familial gout
`Relation between severity and extent of precancerous lesions in the postoperative
`stomach
`CLINICAL PRACTICE
`R. S. Savalgi, C. M. Corbishley, C. Caygill, M. Hill, M. G. Cook, J. S. Kirkham, T. C. Northfield
`Relation between severity and extent of precancerous lesions in the postoperative
`Myeloid neoplasia in children treated for solid tumours
`stomach
`Ching-Hon Pui, M. L. Hancock, S. C. Raimondi, D. R. Head, Elizabeth Thompson,
`R. S. Savalgi, C. M. Corbishley, C. Caygill, M. Hill, M. G. Cook, J. S. Kirkham, T. C. Northfield
`Judith Wilimas, L. E. Kun, L. C. Bowman, W. M. Crist, C. B. Pratt
`Myeloid neoplaSia in children treated for solid tumours
`Comparison of audible sound transmission with ultrasound in screening
`Ching-Hon Pui, M. L. Hancock, S. C. Raimondi, D. R. Head, Elizabeth Thompson,
`for congenital dislocation of the hip
`Judith Wilimas, L. E. Kun, L. C. Bowman, W. M. Crist, C. B. Pratt
`M. H. Stone, N. M. P. Clarke, M. J. Campbell, J. B. Richardson, P. A. Johnson
`Comparison of audible sound transmission with ultrasound in screening
`HEALTH .SCIENCES LIPRARv
`EPILEPSY OCTET
`for congenital dislocation of the hip
`A.0_1
`University of Wisconsin
`M. H. Stone, N. M. P. Clarke, M. J. Campbell, J. B. Richardson, P. A. Johnson
`New antiepileptic agents: strategies for drug development
`R. J. Porter
`EPILEPSY OCTET
`HEALTH SCIENCES LIBRAI3v
`AU 62 8 1990
`New and potential anticonvulsants
`New antiepileptic agents: strategies for drug development
`University of Wisconsin
`M. J. Brodie, R. J. Porter
`R. J. Porter
`,:ottlanagement of epilepsy during pregnancy and lactation
`AUG 2 8 1990
`New and potential anticonvulsants
`1305 Linden Dr.
`0 J> h M. J. m J Brodie
`M. J. Brodie, R. J. Porter
`1
`Madison, Wis. 53706
`BOOKSHELF
`Management of epilepsy during pregnancy and lactation
`Medicine and the Law
`1305 Linden Dr.
`J> 4 M J. Brodie
`The Management of Pain
`405 (cid:9)
`Two anaesthetists convicted of manslaughter
`Madison, Wis. 53706
`Obituary
`Medical Informatics
`~BOOKSHELF
`Medicine and the Law
`Community Integration Following Traumatic
`Brendan Moore
`The Management of Pain
`Two anaesthetists convicted of manslaughter (cid:9)
`Noticeboard
`Brain Injury
`Obituary
`Medical Informatics
`NEWS and COMMENT
`Doctors with HIV; Contaminated L-tryptophan;
`Community Integration Following Traumatic
`Brendan Moore (cid:9)
`Cannabinoid receptor(s); Catheters out!;
`Washington Perspective
`Noticeboard
`Brain Injury
`Access to food safety data
`NEWS and COMMENT
`The genome in the political rough
`Doctors with HIV; Contaminated L-tryptophan;
`Mapping the visual areas of the brain;
`( Round the World
`Cannabinoid receptor(s); Catheters out!;
`Washington Perspective
`Anaesthetic safety checks; Deaf but not dumb;
`USA: Sealing the ozone hole
`432
`Access to food safety data (cid:9)
`433
`The genome in the political rough
`International Nutrition Foundation prize
`Bulgaria: Solidarity of purpose and
`Mapping the visual areas of the brain;
`Round the World
`433
`In England Now
`humanitarianism
`Anaesthetic safety checks; Deaf but not dumb;
`433
`USA: Sealing the ozone hole
`International Diary
`Conference
`433
`International Nutrition Foundation prize
`Bulgaria: Solidarity of purpose and
`LETTERS to the EDITOR
`434-450
`430 (cid:9)
`Alzheimer's disease
`433
`In England Now
`429
`humanitarianism
`433
`International Diary
`The Lancet, North American Edition is published weekly by Williams & Wilkins, 428 E. Preston St., Baltimore, MD 21202-3993. Editorial Information: Ann Dixon. Tel:
`Conference
`1-800-462-6198. Fax: 301-528-4312. Second Class Postage paid at Baltimore, MD, and at additional mailing offices. Postmaster: send address changes (form 3579) to The Lancet,
`LETTERS to the EDITOR (cid:9)
`434-450
`430
`Alzheimer's disease
`Williams & Wilkins, 428 E. Preston St., Baltimore, MD 21202-3993. (ISSN 0099-5355). Copyright © 1990 by The Lancet Ltd for the entire literary matter in The Lancet.
`The Lancet, North American Edition is published weekly by Williams & Wilkins, 428 E. Preston St., Baltimore, MD 21202-3993. Editorial Information: Ann Dixon. Tel:
`1-800-462-6198. Fax: 301-528-4312. Second Class Postage paid at Baltimore, MD, and at additional mailing offices. Postmaster: send address changes (form 3579) to The Lancet,
`Williams & Wilkins, 428 E. Preston St., Baltimore, MD 21202-3993. (ISSN 0099-5355). Copyright © 1990 by The Lancet Ltd for the entire literary matter in The Lancet.
`
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`Ex. 1075 - Page 1
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`

`VOL 336
`VOL 336
`
`THE LANCET
`THE LANCET
`
`439
`439
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`a b
`b
`a
`
`d
`
`e (cid:9)
`e
`
`f
`
`a
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`65 -0-
`65
`45 tri.
`45.-
`
`33 0.-
`33.-
`31 OP-
`31 0.-
`
`16
`16—
`
`a•
`
`1 2345 678 12 (cid:9)
`1 2 3 (cid:9)
`1 2 3 4 5 (cid:9)
`1 2 3 4 5 6 7 8
`12 (cid:9)
`1 2 34 5 678 12 (cid:9)
`1 234 5 (cid:9)
`1 2 3 4 5 6 7 8
`1 2 3 (cid:9)
`1 2 (cid:9)
`Immunoblotting patterns in experiments designed to detect CSL antibodies in CSF
`Immunoblotting patterns in experiments designed to detect CSL antibodies in CSF
`of patients with various neurological diseases.
`of patients with various neurological diseases.
`(a) Amido-black protein stain of partly purified CSL as antigen. Bands at 31-5, 33, and 45 kD
`(a) Amido-black protein stain of partly purified CSL as antigen. Bands at 31 .5, 33, and 45 kD
`are characteristic.
`are characteristic.
`(b) Staining obtained by omitting CSF as first antibody and using labelled goat anti-human
`(b) Staining obtained by omitting CSF as first antibody and using labelled goat anti-human
`antibodies as second antibody.
`antibodies as second antibody.
`(c) Pattern obtained with CSF patients with meningeal haemorrhage due to mechanical
`(c) Pattern obtained with CSF patients with meningeal haemorrhage due to mechanical
`trauma; note background staining with no defined bands.
`trauma; note background staining with no defined bands.
`(d) and (g) Immunodetection of CSL bands using CSF of patients with multiple selerosis as
`(d) and (g) Immunodetection of CSL bands using CSF of patients with multiple selerosis as
`source of CSL antibody. Stained CSL subunits vary from one patient to another, 31.5 kD band
`source of CSL antibody. Stained CSL subunits vary from one patient to another, 31.5 kD band
`being revealed in (d) 1-3 and 45 kD in (d) 4-B; in some cases, 31 .5 and 33 kD subunits were
`being revealed in (d) 1-3 and 45 kD in (d) 4-8; in some cases, 31.5 and 33 kD subunits were
`strongly stained, with a different pattern,of staining for 45 kD.
`strongly stained, with a different pattern.of staining for 45 kD.
`(e) and (f) Same experiments with CSF from patients with neurological diseases other than
`(e) and (f) Same experiments with CSF from patients with neurological diseases other than
`multiple selerosis (non-infectious diseases not affecting blood-brain barrier in [e] and viral
`multiple selerosis (non-infectious diseases not affecting blood-brain barrier in [e] and viral
`meningitis in [f]). In four cases band at 67 kD was immunostained. In one patient, this band was
`meningitis in [f]). In four cases band at 67 kD was immunostained. In one patient, this band was
`observed during acute phase only. Bands at 40 and 27 kD were detected in some cases.
`observed during acute phase only. Bands at 40 and 27 kD were detected in some cases.
`Arrows indicate position of molecular weight markers.
`Arrows indicate position of molecular weight markers.
`Quantitative differences in CSL antibodies in CSF are evident
`be progressively tapered and eventually discontinued, and
`Quantitative differences in CSL antibodies in CSF are evident
`be progressively tapered and eventually discontinued, and
`and not necessarily related to the protein concentration of CSF.
`cyclosporin was replaced by sulphasalazine. Patients then remained
`and not necessarily related to the protein concentration of CSF.
`cyclosporin was replaced by sulphasalazine. Patients then remained
`Measurement of anti-CSL is possible, provided samples are not
`in complete remission for a mean of 3.6 months (range 2-8),
`Measurement of anti-CSL is possible, provided samples are not
`in complete remission for a mean of 3.6 months (range 2-8),
`denatured by storage or handling.
`after which, however, all patients had severe relapses needing
`denatured by storage or handling.
`after which, however, all patients had severe relapses needing
`Our preliminary results with anti-CSL studies in plasma indicate
`surgery.
`Our preliminary results with anti-CSL studies in plasma indicate
`surgery.
`high levels of CSL antibody in the plasma of patients having CSL
`In 2 of the 5 patients in the second group the addition of
`high levels of CSL antibody in the plasma of patients having CSL
`In 2 of the 5 patients in the second group the addition of
`antibody in the CSF but it is too soon to calculate the specificity and
`cyclosporin to the drug regimen failed to modify the clinical severity
`antibody in the CSF but it is too soon to calculate the specificity and
`cyclosporin to the drug regimen failed to modify the clinical severity
`the sensitivity of this approach as a test for multiple selerosis on
`of the colitis, and surgery could not be deferred. The other 3
`the sensitivity of this approach as a test for multiple selerosis on
`of the colitis, and surgery could not be deferred. The other 3
`plasma or serum.
`patients showed a progressive clinical improvement after a mean of
`plasma or serum.
`patients showed a progressive clinical improvement after a mean of
`7 days on cyclosporin, after which the steroid dose could be tapered
`7 days on cyclosporin, after which the steroid dose could be tapered
`CNRS Neurochemistry Centre
`and the drug eventually stopped. These 3 patients then received 2
`CNRS Neurochemistry Centre
`and INSERM U44,
`and the drug eventually stopped. These 3 patients then received 2
`and INSERM U44,
`mg/kg daily azathioprine; 2 patients are still in remission after 1 year
`5 rue Blaise Pascal,
`mg/kg daily azathioprine; 2 patients are still in remission after 1 year
`J.-P. ZANETTA
`5 rue Blaise Pascal,
`and 3 months, respectively, whereas the third underwent surgery
`67084 Strasbourg, France
`67084 Strasbourg, France (cid:9)
`J.-P. ZANETTA
`and 3 months, respectively, whereas the third underwent surgery
`after 9 months' follow-up owing to severe, acute exacerbation of
`after 9 months' follow-up owing to severe, acute exacerbation of
`Cyclosporin treatment for severe active
`ulcerative colitis.
`Cyclosporin treatment for severe active
`ulcerative colitis.
`ulcerative colitis
`These data are in accord with those of Baker and Jewell' and seem
`ulcerative colitis
`These data are in accord with those of Baker and Jewell' and seem
`to confirm that cyclosporin, whether given orally or parenterally,
`SIR,—We read with great pleasure Dr Lichtiger and Professor
`to confirm that cyclosporin, whether given orally or parenterally,
`does not appear to have the capacity to prevent surgical treatment of
`SIR,—We read with great pleasure Dr Lichtiger and Professor
`Present's report (July 7, p 16) of the use of cyclosporin in the
`does not appear to have the capacity to prevent surgical treatment of
`the severe forms of ulcerative colitis.
`Present's report (July 7, p 16) of the use of cyclosporin in the
`treatment of severe ulcerative colitis. We would draw attention to
`the severe forms of ulcerative colitis.
`G. BIANCHI Pomw
`treatment of severe ulcerative colitis. We would draw attention to
`our experience.
`G. BIANCHI PORRO
`Gastrointestinal Unit,
`M. PETRILLO
`our experience.
`Gastrointestinal Unit,
`Between 1986 and 1989, 10 patients with severe ulcerative colitis
`L. Sacco Hospital,
`M. PETRILLO
`L. Sacco Hospital,
`Between 1986 and 1989, 10 patients with severe ulcerative colitis
`S. ARDIZZONB
`20157 Milan, Italy
`who were refractory to standard medical treatment
`S. ARDIZZONE
`20157 Milan, Italy
`who were refractory to standard medical treatment
`1. Baker K, Jewell DD. Cyclosporin for the treatment of severe inflammatory bowel
`(methylprednisolone 40 mg/day intramuscularly, hydrocortisone or
`disease. Aliment Pliarmaeol Ther 1989; 3: 143-49.
`1. Baker K, Jewell DD. Cyclosporin for the treatment of severe inflammatory bowel
`(methylprednisolone 40 mg/day intramuscularly, hydrocortisone or
`5-acetylsalicylic acid suppositories, total parenteral nutrition, and
`disease. Aliment Phannacol Ther 1989; 3: 143-49.
`5-acetylsalicylic acid suppositories, total parenteral nutrition, and
`antibiotics) and were therefore candidates for surgical treatment
`GISSI-2: 10% reduction in mortality with
`antibiotics) and were therefore candidates for surgical treatment
`GISSI-2: 10% reduction in mortality with
`were given cyclosporin according to an open protocol. In 2 men and
`heparin in acute myocardial infarction?
`were given cyclosporin according to an open protocol. In 2 men and
`heparin in acute myocardial infarction?
`3 women (aged 27-40 years), cyclosporin was given orally at a mean
`3 women (aged 27-40 years), cyclosporin was given orally at a mean
`SIRS In GISSI-2 and its international extension (July 14, p 65;
`dose of 8.5 mg/kg daily for 5-6 weeks. In the other 5 patients (1
`SIR,—In GISSI-2 and its international extension (July 14, p 65;
`dose of 8.5 mg/kg daily for 5-6 weeks. In the other 5 patients (1
`July 14, p 71), patients with suspected acute myocardial infarction
`male, 4 female, 13-45), cyclosporin 4 mg/kg daily was given
`July 14, p 71), patients with suspected acute myocardial infarction
`male, 4 female, 13-45), cyclosporin 4 mg/kg daily was given
`(MI) were given a fibrinolytic agent and aspirin immediately, and
`intravenously for at least 10 days.
`(MI) were given a fibrinolytic agent and aspirin immediately, and
`intravenously for at least 10 days.
`were allocated randomly to receive either no routine anticoagulation
`In the first group clinical condition greatly improved (substantial
`were allocated randomly to receive either no routine anticoagulation
`In the first group clinical condition greatly improved (substantial
`or 12 500 U heparin twice daily, starting 12 h after the beginning of
`reduction of the number of daily defecations, disappearance of
`or 12 500 U heparin twice daily, starting 12 h after the beginning of
`reduction of the number of daily defecation, disappearance of
`fibrinolytic infusion and continuing until hospital discharge.
`blood from faeces) after a mean of 4 weeks, and there was a striking
`fibrinolytic infusion and continuing until hospital discharge.
`blood from faeces) after a mean of 4 weeks, and there was a striking
`During the first 12 h, therefore, anticoagulant treatment in the "no
`reduction in the degree of inflammatory activity. Plasma
`During the first 12 h, therefore, anticoagulant treatment in the "no
`reduction in the degree of inflammatory activity. Plasma
`heparin" and "heparin" groups should have been similar, and
`cyclosporin concentrations remained within the normal therapeutic
`heparin" and "heparin" groups should have been similar, and
`cyclosporin concentrations remained within the normal therapeutic
`consequently any differences in mortality during this time are likely
`range (400-700 mg/ml) in all cases. This allowed the steroid dose to
`consequently any differences in mortality during this time are likely
`range (400-700 mg/m1) in all cases. This allowed the steroid dose to
`
`Ex. 1075 - Page 2
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